Acute renal failure

Despite the wide range of dialysis modalities available, patients with acute renal failure (ARF) still face a mortality rate of approximately 50% (1). Depending on its severity and duration, ARF can be transient and, with specialist medical and nursing management, the patient may regain a normal renal function. However, the patient may be left with degree of chronic renal impairment or even irreversible renal failure.

Bhandari and Turney reviewed survival rates of over 1095 patients with severe dialysis-dependant ARF over a 10 years (2). Although the cause of ARF plays an important role in the survival rates, they found that of the 59.5% that survived, 16.2% remained dialysis dependant. The psychological needs of a patient confronted with unexpected End-Stage Renal Failure, or that of a family faced with a sudden death, can not be underestimated.

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	The oliguric phase of ARF is best defined by a 24-hour urine volume of which of the following? (Choose one only).
		100 - 400mls
		400 - 800mls
		< 100mls
		>1000mls
	Acute Renal Failure can be categorised into three classifications:
		pre-renal failure;
		intra-renal failure (or intrinsic); and
		post-renal failure.
	Define these three categories stating their main causes and presentation.
	A breakdown of lean body mass during catabolic renal failure can lead to elevated serum levels of which of the following? (Choose one only).
		Bicarbonate and sodium
		Potassium and phosphorous
		Potassium and sodium
		Calcium and phosphorous
	Which of the following are clinical indications for dialysis therapy in ARF? (Choose all possible responses).
		Severe hyperkalaemia, plasma K+ > 6.5mmol/l
		Symptomatic uraemia: eg, pericarditis, encephalopathy
		Severe fluid overload
		Intoxication with dialysable substances
		Severe metabolic acidosis
	Haemodialysis and haemofiltration (in a variety of forms) are often used in ARF. Briefly outline both the similarities in treatment, and the main differences.
	The Renal Association(3) recommends that patients with Acute Renal Failure involving the kidney alone should be offered which of the following range of treatments in which environment? (Choose one only).
		In a renal ward which has its own haemodialysis facilities
		In an acute renal failure treatment area, with all dialysis modalities available
		In either a renal ward or ARF treatment area, offering a full range of treatment modalities and facilities appropriate to a High Dependency Unit (HDU) setting.
		In a HDU or Intensive Care with haemodialysis and haemofiltration facilities available